Wolford (25, 30) developed a technique for closure of the oronasal fistulas associated with the alveolar clefts.
The treatment included 1) presurgical orthodontics to align and level the teeth in each dental arch; 2) stage 1 surgery at age 17 years, including maxillary osteotomies to advance, expand, and open space for the maxillary lateral incisors, closure of the bilateral oronasal fistulas, and bone grafts to the bilateral alveolar clefts (Figure 6b); 3) postsurgical orthodontics; 4) restorative dentistry to replace the maxillary lateral incisors; and 5) stage 2 surgery, including external rhinoplasty and columella reconstruction with cartilage grafting and revision of the bilateral cleft lip.